Endocrine Abstracts

Prolactinoma represents 27 to 35% of pituitary adenomomas and 40 to 75% of secreting adenomas. However, the macroprolactinomas are not frequent. We report clinical, biological and therapeutic aspects of 5 cases of macroprolactinomas. It concerns 3 women and 2 men. The average age is 43.4 years (19–68). The reason for seaking medical advice was amenorrhea – galactorrhea syndrom in 2 women and infertility in one case. The diagnosis of pituitary adenoma is incidentally imaged when computed tomographic scan is done because of stroke in 2 patients. Clinically, complete impotence and gynecomastia are present in only one man. The average concentration of prolactin is 2171.2 ng/ml (200–9134). There is no symptoms of acromegaly. Corticotropin deficiency is noted in 3 cases. Two patients present somatotropic deficiency. Thyrotropin deficiency concerns one case. The pituitary MRI shows a large tumor that extends beyond the confines of the sella turcica in four cases. This tumor is responsible of headache and visual abnormalities in 2 cases. All our patients are treated with bromocriptine, the only dopamine agonist avalable in Tunisia. No one experienced nausea and postural hypotension. The average dose was 12.37 mg/day. The serum prolactin level is normalised in 4 patients. Surgical resection is considered in one patient who fails to respond to medical treatment. Some degree of tumor shrinkage occurs in 3 cases. One patient was dead after 3 months of begining of treatment. The treatment should lowering serum prolactin levels, reducing tumor size and improving visual fields.

Successful treatment of macroprolactinoma is most often accomplished with administration of a dopamine agonist. The results of dopamine agonist treatment in patients with macroprolactinomas are similar to those in patients with microprolactinomas. Surgical therapy and pituitary radiation may be used as adjunctive therapy.